Is the CMS Hospital-Acquired Condition Reduction Program a Valid Measure of Hospital Performance?

Area of Science:

• Health Services Research
• Healthcare Policy
• Quality Improvement

Background:

• The Centers for Medicare & Medicaid Services implemented the Hospital-Acquired Condition Reduction Program (HACRP) in 2014.
• HACRP reduces Medicare payments by 1% for hospitals in the bottom quartile of performance.
• This program aims to incentivize reductions in hospital-acquired conditions.

Purpose of the Study:

• To evaluate the sensitivity and validity of the HACRP measure.
• To assess the impact of small performance changes on penalty status.
• To examine the correlation between HACRP scores and hospital characteristics.

Main Methods:

• Analysis of HACRP scores and penalty status for hospitals.
• Statistical examination of score clustering around the penalty threshold.
• Correlation analysis between HACRP scores and hospital characteristics, including case mix index.
• Comparison with an alternative method for measuring hospital complication performance.

Main Results:

• A significant clustering of HACRP scores around the penalty threshold was observed.
• 13.2% of hospitals were susceptible to penalty shifts from minor changes in component measures.
• The HACRP score showed a significant correlation with hospital characteristics like case mix index.
• This correlation was not replicated using an alternative performance measurement method.

Conclusions:

• The HACRP measure's sensitivity to minor performance fluctuations raises concerns about its reliability.
• The correlation of HACRP scores with hospital characteristics suggests potential confounding factors in risk adjustment.
• The validity of the HACRP measure and its risk adjustment methodology warrants further investigation.